BACKGROUND:
Celiac disease (CD) is one of the most common lifelong disorders in
western countries. However, most cases remain currently undiagnosed in
North America, mostly due to poor awareness of CD by primary care
physicians.
OBJECTIVES: The aims of this study were (a) to
determine whether an active case-finding strategy in primary care could
increase the frequency of CD diagnosis and (b) to determine the most
common clinical presentations of the condition.
METHODS:This
was a multicenter, prospective study involving adult subjects during
the years 2002–2004, attending one of the participating practices. All
individuals with symptoms or conditions known to be associated with CD
were tested for immunoglobulin A anti-transglutaminase (tTG)
antibodies, and those with elevated anti-tTG were subsequently tested
for IgA antiendomysial antibodies (EMA). All subjects who were positive
for EMA were advised to undergo an intestinal biopsy and HLA typing.
RESULTS:
The study group included 737 women and 239 men, with a median age of
54.3 yr. A positive anti-tTG test was found in 30 out of 976
investigated subjects (3.07%, 95% CI 1.98–4.16). CD was diagnosed in 22
patients (18 women, 4 men). The most frequent reasons for CD screening
in these 22 cases were bloating (12/22), thyroid disease (11/22),
irritable bowel syndrome (7/22), unexplained chronic diarrhea (6/22),
chronic fatigue (5/22), and constipation (4/22). The prevalence of CD
in the serologically screened sample was 2.25% (95% CI 1.32–3.18). The
diagnostic rate was low at baseline (0.27 cases per thousand visits,
95% CI 0.13–0.41) and significantly increased to 11.6 per thousand
visits (95% CI 6.8–16.4, P < 0.001) following active screening implementation.
CONCLUSIONS:
This study demonstrates that an active case-finding strategy in the
primary care setting is an effective means to improve the diagnostic
rate of CD in North America.
(Am J Gastroenterol 2007;102:1454–1460)
